Improvements in life expectancy in England have stalled for the first sustained period in 120 years after a decade of government austerity, according to one of the world’s leading experts on the link between social deprivation and health.
Describing his findings as “shocking”, Michael Marmot, who heads the Institute of Health Equity at University College London, highlighted rising child poverty, declines in education funding, an increase in zero-hours contracts and the large number of people resorting to food banks. The result was “ignored communities with poor conditions and little reason for hope”.
Sir Michael told the Financial Times: “I’m not saying ‘austerity is killing people’. I’m saying it’s highly likely — because we identified the key drivers of health and health inequalities, and because they’ve changed in an adverse direction — that those changes are responsible for the health effects that we see.”
He has drawn a stronger link between austerity and the slowing increase in life expectancy than in his last report, in 2017.
The findings, particularly evidence of a widening north-south divide, are likely to make uncomfortable reading for Boris Johnson, the prime minister, whose 80-strong parliamentary majority was driven by support in traditionally Labour seats in some of the most deprived parts of the country.
In his original report, commissioned by the then Labour government and published in 2010, Sir Michael identified six areas that constituted “the social determinants of health”. They included early child development, education and life-long learning, employment and working conditions and the minimum income needed for healthy living.
A recent analysis by the Health Foundation, the charity that commissioned Sir Michael’s report, found that voters in the so-calledred wall seats, which switched to the Conservatives at last year’s general election, had fewer years in good health than people in seats the party already held.
Noting that these areas had predominantly voted Leave in the 2016 EU referendum, Sir Michael suggested that Brexit was “a symptom, rather than a cause”, of such inequalities.
Ten years of rolling back the state had resulted in “widespread reductions in public spending and intervention in almost all areas; and, at the same time, social, economic and regional inequalities have deepened”, Sir Michael’s report said.
The largest decreases in life expectancy were seen in the most deprived 10 per cent of neighbourhoods in the North East, and the largest increases in the least deprived 10 per cent of neighbourhoods in London.
These declines need not have happened, the report suggested. In 2010, public expenditure had amounted to 42 per cent of gross domestic product “and that’s now 35 per cent. And that’s a political decision,” Sir Michael said.
Local government leaders and health organisations described the findings as “a wake-up call” for government.
Jennifer Dixon, the Health Foundation chief executive, said where there had been progress towards addressing inequalities, it had been “fragmented and underpowered”. Areas that needed immediate investment include child and in-work poverty, the public health grant to local authorities, and children’s services such as Sure Start, she added.
The prime minister has promised action to “level up” the economic performance of poorer regions.
Matt Hancock, the health secretary, did not dispute Sir Michael’s conclusions. “His findings show just how important this agenda is, and renew my determination to level up health life expectancy across our country,” he said. “After all, levelling up health is the most important levelling-up of all.”
Sir Michael called on Mr Johnson to set up a cross-departmental committee to oversee the action needed to tackle health inequalities.
The report said that from the beginning of the 20th century, England experienced continuous improvements in life expectancy but from 2011 those improvements “slowed dramatically, almost grinding to a halt”.
For part of the decade 2010-2020 life expectancy actually fell in the most deprived communities outside London for women and in some regions for men. “For men and women everywhere the time spent in poor health is increasing,” he added.
Between 1981 and 2010, life expectancy at birth increased by about a year every five-and-a-half years for women and every four years for men. Between the years 2011 and 2018, however, that slowed to a one-year increase every 28 years for women and 15 years for men.
At the time of the 2010 Marmot Review, commissioned by then prime minister Gordon Brown amid concern at widening health inequalities, life expectancy for babies born in England had been 78.7 years for males and 82.6 years for females.
By 2018 it was 79.6 years for males and 83.2 years for females — increases of only 0.9 years for men and 0.6 years for women. A decade earlier, between 2000 and 2008, the increases were 2.2 and 1.5 years, respectively.
Death rates are increasing for men and women aged 45-49, the report found — perhaps related to the so-called “deaths of despair”, a description first coined in the US to describe deaths from suicide, drugs and alcohol abuse.
The picture in comparable countries is less bleak, Sir Michael stressed. There had been “austerity right across Europe” but it had been “more severe” in the UK, he said.